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1) Sorry, to ask, but if the hiv is only able to reproduce itself through the CD4 then, does it means that without CD4, the VL will remain stable ? I read somewhere that the lifespan of the VIH is of 1.2 days.

If that's true, then why if the CD4 count decrease, the VL did not decrease as well ?

2) Why if the CD4 = 0, the virus is not dying (excepting the those dormant) ?3) Why don't we cultivate our CD4 to then re inject them so they outnumber the number of virus ?

Like there is a critical mass in the universe, there must be a critical ratio between CD4 vs. VL above what, the virus can't defeat the CD4 (but the opposite) ?How can we explains then that the existing drugs allows to get a good CD4 and an undetectable VL, and despite that, the CD4 are unable to beat the virus ?

4) Why a treatment can't be stopped once we get a good count result ?

5) Eating healthy does make the virus healthy as well ?

6) What are the criteria that define a CD4=350 and or VL>100K = > treatment. Why not 500 ?

1) The virus replicates many times in a cell. If you have 1 CD4 it will still replicate in that CD4.2) If the CD4 is zero and you do not take treatment you will die before the virus dies.3) Stem cell research is new technology.3a) As I said above, it's not a 1:1 ratio, the virus uses 1 cell to make plenty of new viruses. So even if you had 3000 CD4s, you'll still have much more virus being created and still put a serious burden on your immune system.3b) The drugs prevent the virus from entering the cell, disable its replication inside the cell or exiting the cell. Current treatment is a combination of all (except exiting the cell is still in study).

Remember that this virus is unlike others, it infects the cells that are supposed to help our immune system. Other viruses infect other types of cells and immune system can launch a full battle against them. In the case of HIV the more you create CD4s to fight the more virus you create too.

4) Being undetectable doesn't mean there is no virus left. When you stop medication, the virus is able to multiply again.5) Being alive makes the virus healthy. The proteins you ingest are used by your body, your cd4s and therefore make the virus happy.6) The drugs that were used in the 80s and 90s had bad side effects, and adherence is extremely important. It has been a trend to wait as much as possible before starting HAART so that the patient gets his or her mind set about adherence and continues taking drugs despite the side effects. Remember, once you start it is for life.

The recent drugs have considerably reduced the side effects but adherence is still important. There are studies right now that look at the benefits of starting HAART earlier than before.

- the life expectancy of the virus is of 1.2 days- and if the CD4 = 0 the virus can't replicate

then it should be possible to survive a week in a bubble room no ?

3) I do not understand why once the body have detect the virus, their is not a CD4/VL ratio above what, the CD4 can exterminate the virus.I do understand that 1 CD4 can create X virus (X>1) but we take the example where the ratio is greater than a "critical" value (like a critical mass)

5) What about taking vitamins then ? What about eating proteins (whey for eg) ? To avoid ?

6) Sorry, what is the reason behind not stopping a treatment ? And does it make sense today to start a treatment at CD4=500 ? Seems that the CD4 will then be able to reach then the normal range. Then, instead having to fight the virus, the body will have to eliminate the waste generated by the drugs. Probably more healthy no ? And the toxicity seems to decrease with the research.

2) Not only live in a bubble room but also have biopsies from your gut, your thymus, your lymph nodes, your lymphatic system etc etc to ensure that there is not a single copy of the virus anywhere. It's not something that current science could do an achieve a 100% straight result declaring that your virus has gone.

3) There is a rise in CD4 once the virus is detected. But then the virus takes over.

5) There are other discussions about supplements in those forums. There are claims that some supplements increase the CD4 activity, but there has not been many serious studies to backup those claims. Use the "search" function to see the discussions about supplements.

6) I'd rather have someone more experienced to response about treatment, as this is not something I have knowledge about.

Below my argument for starting the HAART as soon my CD4 will goes under 500.

My I ask your opinion ?

Arguments for an early HAART treatment

* 500 is the lower limit of an healthy immune system. * CD4 is only the visible part of the iceberg. It's just an average indicator. It doesn't say individually in how good shape is our brain or any others vital organs. So some might have already suffer to cause potentially sooner or later new diseases that the drugs toxicity and average body condition won't help to cure * the trend is already to start earlier the treatments (we already have raised the threshold from 200 to 350, at this time a debate was also on going) and now the debate is about raise it to 500. * It seems that we are loosing between 50-100 CD4 / years. So going from 500 to 350 will take between 18 months to 3 years. Not that much ! On the opposite, starting earlier seems to shows a better tolerance of the body on the treatment. So what is lost in one side (time before starting the treatment 500 against 350) might potentially be gained on the other side (duration of the body acceptance of the drugs). * If on the average, the CD4 will typically double under HAART, the body will be in a better position (30% ! 700 against 1000) to fight the first infection, could it be just a flu. Infection during which the virus will gain ground. * Finally, it's also about getting a margin in case of problems: if the treatment start at 500, and if then the CD4 reach 1000 under HAART, then there is a 500 CD4 margin before our immune systems is considered as weak. Starting at 350 will offer a margin of 200. * The doubling of CD4 once under HAART is only an estimation. It take also time to happen. Time during which the immune system is weakens (<500). In more, the coefficient 2 is also an estimation. What if for some, it is of 1.5 ?

Its very personal choice of course, and everybody will decide for himself, taking into consideration his doctor advises. Advises that are still evolving..

In my opinion, the camp advocating earlier treatment at 500 has some new components, mainly that there are new drugs that are emerging that are better tolerated than the old ones.

However, in discussions with my specialist who has been in the field for years, he is still comfortable in working the 350 ranges as the demarc to treatment. Essentially, and this is a case by case assessment based upon how each individual is able to manage the virus, OI's or opportunistic infections rarely occur in patients with CD4 above 350. While 500 is the minimum "normal" level, 350 is still viewed as functional. From my personal experience, I seem to be doing pretty well, I don't get sick that often if at all.

And while the new treatments are better tolerated, nothing is perfect as the drugs still do have potential toxicity or side effect issues. One still needs to built a cocktail of 3 anti viral agents, which usually involves perhaps a really well tolerated drugs mixed perhaps with one of the older less well tolerated drugs. So while there seems to be alot of good things about reataz, one may still have to take the booster norvir, which can cause digestive issues, or one might use reataz with epzicom, which may have kidney related side effects.

While I would like to be able to overcome the mental roadblock I feel about that moment when i have to go on medical treatment, its there. Right now I'm comfortable delaying my treatment until my specialist advises me to reconsider based upon new developments in treatment.

But if you compare your arguments with mine in bold (I'm absolutely not here to be right but make the right decision!), don't you think its still better to start earlier ?

1) It seems that we are loosing between 50-100 CD4 / years. So going from 500 to 350 will take between 18 months to 3 years. Not that much !On the opposite, starting earlier seems to shows a better tolerance of the body on the treatment.

So the time (ts500-ts350) is lost in one side (ts500=date starting @ 500, ts350=date starting @ 350) might potentially be gained on the other side (tt500-tt350) (tt500=drug duration tolerance @ 500, tt350 = drug duration tolerance @ 350).

ts500-ts350 = tt500-tt350 (around)

2) If on the average, the CD4 will typically double under HAART, the body will be in a better position (30% ! 700 against 1000) to fight the first infection, could it be just a flu. Infection during which the virus will gain ground.

How your body is managing the virus is how your body is managing it, its is not all that certain that certain algorithms are anything but averages or estimates.

For example, My VL at my last test was lower than when I was first diagnosed, And my CD4 count has rebounded upward after a dip.

CD4 is a relative marker among several markers, CD4 and CD8 count and Percentage and Viral Load. And there are differences between camps of thought which includes that CD4 may not be a significant a marker as Viral Load.

So while your CD4 is still in the normal range, your Viral load at under 2 thousand is perhaps more significant. I have seen postings on here where CD4 was relatively high but VL was also surprisingly high as well.

That's why the classic guidelines talk about various markers in combination, where if VL is > 100,000 one should consider medication, or if CD4 is below 350 and combinations of the two.

But I'm not trying to talk you out of should you go on meds. Certainly there are advantages, and if you have set this limit in your mind, I see nothing wrong with that. Having the right attitude at the right time is a very important factor in being treated successfully. There are so many of us scared to death of treatment, they put off, probably too long, when to start. If this is your time, you certainly don't need our concurrence to proceed. In fact, I'm sure there are many of on here who would like to know more about your results and how you feel and are faring under treatment. These types of experiences are important to us as a community in helping us get over the barrier that turning to treatment often represents.

In this videocast from the International AIDS Society Conference in Sydney, Peter Staley interviews Dr. Fred Gordin from George Washington University, who explains why many experts think we might be waiting too long to put patients on HIV treatment. Dr. Gordin is also leading the effort to launch a large clinical trial called START, which hopes to determine if starting treatment at higher CD4 counts will save more lives. "

2- Source: http://www.medpagetoday.com/HIVAIDS/CROIMeeting/tb/5157February 28, 2007A multivariate Cox proportional hazards analysis showed that every increase of 100 CD4 cells reduced the risk of an opportunistic infection by 53%, which was significant at P<0.01.At the same time, every 100-cell increase reduced the risk of a non-opportunistic event by 16%, he said, which was also significant at P<0.01.

In other words, he said, as the CD4 count rises, the rates of non-opportunistic diseases decline -- but not as quickly as the traditional opportunistic infections.

3- Source: http://www.eurekalert.org/pub_releases/2004-09/idso-sat090104.php1-Sep-2004Should AIDS therapy be used earlier than current guidelines recommend?The results: Mortality among HIV-infected injection drug users with CD4 cell counts greater than 350/žL who received HAART (24.1/1,000 person-years) was similar to that of HIV-seronegative injection drug users (19.9/1,000). Furthermore, both groups had lower mortality than HIV-infected subjects with CD4 cell counts greater than 350/žL who did not receive HAART (43/1,000) and those with CD4 counts between 200/žL and 350/žL who did receive such therapy (50.5/1,000). "Assuming that the goal of HIV treatment is to produce outcomes similar to those seen in HIV-negative persons," said the investigators, "our results suggest initiating or switching to HAART at higher CD4 counts than in current recommendations."

Pre-conclusions

My conclusion is for the time being as follow:When my 3 last CD4 average will goes under 500, I'll start the HAART.I'll start earlier if the VL > 100k

You are more than welcome to discuss this topic here, either because you have the same interrogation or because you have arguments pro or cons.

Such discussion/debate is extremely important for me as I believe it should be for anyone.

This is an extremely difficult question to answer, but at the poz life weekend where Dr.s and my experienced people were, they said, never make a decision on one blood test, get three over a period of a month or two, if they all come back under 350 then I am going on meds

if two of 3 come back then I am not sure.

If only one I will wait 3 or more months.

I agree that the 18 mo. to 3 years is not that long but, it also could be 5 or 7 years depending on how well your body handles the fight.

I talked to a guy and he said you can go for 9 years before starting -- based on my numbers. It is a very very difficult decision.I watched a 3 hour lecture a few months ago by UCLA top clinical dr. and all evidence seems to say 350 is about the same as 500 as far as being able for the body immune system to jump back to close to normal.

* It seems that we are loosing between 50-100 CD4 / years. So going from 500 to 350 will take between 18 months to 3 years. Not that much ! On the opposite, starting earlier seems to shows a better tolerance of the body on the treatment. So what is lost in one side (time before starting the treatment 500 against 350) might potentially be gained on the other side (duration of the body acceptance of the drugs).

That's a generalization. Various people see various speed of disease progression. Far from everyone is losing 50-100 CD4 / year. 100 would be for the fast progressors. Many people also lose them at a much lower rate.

that's one way to look at it. also some people can go for years without resistance. another way to look at it is that new drugs do come out and get approved and new clinical trials too

I hear you. You still play a game of russian roulette there as there's no way to know if a combo will work for a long time or not... so starting treatment early when your immune system is still capable to fend off OI means that you will take a risk without really needing to...